Utilization Management

A process used to control costs by case assessment of appropriateness, effectiveness and duration of a hospitalization. This includes pre-certification to the hospital admission, concurrent review of the effectiveness and the duration of the hospital stay as well as discharge planning.

As a leading medical management company, IMS Managed Care utilizes board-certified specialist physicians to perform an independent review of all claims and pre-authorizations which have been initially denied and are being appealed by our clients’ members. Not only is this a recognized Best Practice in US healthcare today, but it is legally mandated in most states as well as federally under ERISA statutes.

All independent medical reviews must meet the highest standards of quality, objectivity, timeliness and cost containment. In order to ensure this, IMS Managed Care has a long-standing partnership with AllMed Healthcare Management, a leading national Independent Review Organization (IRO) which is URAC-accredited and consistently meets our requirements for independent medical review.

Providing specialist-matched independent review of complex and critical claims and pre-authorizations is an integral component of our core strategy of delivering exceptional value to our client groups and their members:

• For your company, you can be sure that all unnecessary treatments and procedures are reduced or eliminated, since strict standards of medical evidence are applied to your health plan policy language.
• At the same time, you can also be sure that your employees receive the benefits they deserve as defined by your plan language and documented standards of care.
• For your employees and their dependents, they can trust that all appeals and pre-authorizations have been subjected to the scrutiny of a specialist in active practice, who applies the latest medical evidence and coverage criteria to making an objective determination. They also will know that your company is in full compliance with all legal requirements and is dedicated to unbiased consideration of all healthcare claims.

Case Management

A collaboration process which promotes high quality care with cost effective outcomes enhancing the physical, psycho-social and vocational health of individuals. The ultimate goal is to promote high quality cost-effective care while advancing the patient's best interest, monitoring services for effectiveness and maximizing benefits for the participant.

IMS Wellness Works – Targeted Population Management

Our approach differs from traditional disease management in that we are broadly assessing the health of individuals to stratify them into three risk groups rather than identifying them soley by disease burden. In additional, programming directs member to our Wellness Works website to educate member to independently manage their health. Interventions are developed and implemented when and where members need them most. Interval follow up is provided by our licensed Care Management staff and is meant to compliment the treatment plan in place for members.   Please click here to view our brochure

Reporting Services

• Monthly Case Management Reports
• Case Management Report For Each Participant
• Quarterly Utilization Review Reports